Provider Demographics
NPI:1831318567
Name:INSTITUTE FOR COMMUNITY LIVING, INC.
Entity Type:Organization
Organization Name:INSTITUTE FOR COMMUNITY LIVING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:JASON
Authorized Official - Last Name:FAST
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-855-7485
Mailing Address - Street 1:26 GANUNG DR
Mailing Address - Street 2:
Mailing Address - City:OSSINING
Mailing Address - State:NY
Mailing Address - Zip Code:10562-3935
Mailing Address - Country:US
Mailing Address - Phone:718-855-7485
Mailing Address - Fax:718-855-1316
Practice Address - Street 1:26 GANUNG DR
Practice Address - Street 2:
Practice Address - City:OSSINING
Practice Address - State:NY
Practice Address - Zip Code:10562-3935
Practice Address - Country:US
Practice Address - Phone:718-855-7485
Practice Address - Fax:718-855-1316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty